Step 1 Medical Boards now Pass/Fail. Good or bad?

By now everyone has heard the bombshell that was dropped by the National Board of Medical Examiners (NBME) on February 12 about transitioning the Step 1 exam from a 3-digit numerical score to a pass/fail outcome starting in 2022. For those of you who do not know, this is the exam that is typically taken by second year medical students to complete the scientific training portion of their medical education. It contains mostly what is referred to as the three-Ps: Physiology, Pathology, and Pharmacology with a little microbiology and anatomy also sprinkled in there. Traditionally the score on this exam has been one of the strongest measures on what specialty a medical student can go into after completing their M.D. Now a big wrench has been thrown into that process, so what do we think? Good or Bad? I’ll try to be brief.

Most medical students cite this exam as the black hole of medical school and the worst period of their entire medical education. This stress level was actually one of the major reasons why the NBME went to the pass/fail option. Susan Skochelak, Chief Academic Officer for the AMA commented on this change saying that “Our student, resident, and physician members voted to endorse a pass/fail policy, in part because we know that our current residency selection system is causing significant distress for our students.”

I agree with this assessment, the extent of scientific knowledge that is demanded by medical students cannot simply be evaluated with a single 8-hour exam. But is making one exam pass/fail really the change in medical education that we need? Many schools already have a pass/fail curriculum and Step 1 was a chance for students to set themselves apart from the crowd. Now the focus shifts to the Step 2 exam which is given in two parts: CS – an in person clinical skills test and CK – a written exam given after year 3 which covers the clinical clerkships learned during the 3rd year of medical school. The CS has already been pass/fail and the CK will remain a scored exam.

In my opinion such a shift in policy now requires the shift in medical education that has been needed for years. Since there will be less focus on the score of the scientific knowledge, the medical education system needs to change their baseline curriculum to reflect the change that this brings. Most medical students do not go to class already because they are focusing on boards, what is a pass/fail option going to do to attendance now? I think this is the chance for medical schools to make the scientific knowledge part of the required reading prior to entering a classroom and make the classroom more interactive and hands-on. Make the first two-years of medical school more condensed and make the scientific knowledge part of the future case studies that will be relevant to their practice of medicine. Many schools already have this kind of process through a problem-based learning (PBL) curriculum.

I think this is a step in the right direction (no pun intended). In this new age of modern medicine we need to think about ways to best train the scientists and physicians of the future. I am interested in seeing the data 20 years from now about how this has changed the way medical students learn and how medical schools adapt to this new policy. What is your opinion about this new policy change? Is this change good or bad for medical education?Share in the comments!

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